OBJECTIVES: To estimate the direct and indirect costs of bladder cancer prior to and following cystectomy.

METHODS: This study was a retrospective analysis of de-identified bladder cancer patients appearing in the MarketScan Commercial Claims & Encounters and Health & Productivity Management databases (10/1/2015 – 12/31/20). Inclusion criteria: 1) ≥ 1 claim containing a procedure code for cystectomy and a diagnosis code for bladder cancer (date of the cystectomy = index date); 2) 18+ years of age on index; and 3) 6 months of continuous enrollment prior to (baseline) and following (follow-up) index. All-cause total healthcare costs and indirect costs associated with short-term and long-term disability (STD and LTD) employer claims were assessed during baseline and follow-up. Descriptive analyses were performed.

RESULTS: Overall, 142 patients met inclusion criteria. The mean patient age was 56±6 years, 76% were male, and 42% of patients presented a baseline Deyo-Charlson Comorbidity Index ≥ 2. During baseline, patients incurred total all-cause direct healthcare costs of $47,781 ± $44,300, which increased to $99,259 ± $77,389 during follow-up. Regarding indirect costs, 32% of patients filed ≥ 1 STD claim during baseline, equating to a mean of 134 ± 303 hours lost and $2,353± $6,445 in total payments per patient. The rate of patients filing an STD claim increased 23.4% during follow-up, and was associated with 218 ± 324 hours lost and $3,679± $7,795 in total payments. The rate of LTD claims also increased from baseline to follow-up (1.4% to 2.8%), and among patients with ≥ 1 LTD claim post-cystectomy, resulted in 574±490 hours lost, and $1,636±$1,429 in total payments.

CONCLUSIONS: Cystectomy imposes a substantial economic burden on patients and is associated with decreased work productivity in the period following surgery. Further studies should investigate the impact of bladder-sparing treatment options on clinical and economic outcomes in patients at-risk for cystectomy.